Primary Care and Population Medicine Residency Program

The goals of this residency program are:

  • To provide comprehensive inpatient and outpatient clinical training of the highest quality for general internists;
  • To develop a broad understanding of the determinants of population health and its relation to medical practice, and the analytical and management skills required to improve care, lead health systems, and develop sound health policy;
  • To enhance leadership and management skills through mentorship, seminars and other curricula, and progressively increasing responsibility for those components of the program of particular relevance to the residents’ interests and developing career goals.

Program Details

Our Partnering Institutions

This program is based on a unique and innovative 25-year collaboration among four institutions:

Brigham and Women’s Department of Medicine, recognized as one of the country’s top teaching hospitals and one of the best places in the nation for residency training.

Harvard Vanguard Medical Associates (HVMA)/Atrius Health, a non-profit multispecialty group practice nationally recognized for excellence in patient care, quality improvement, and the use of cutting-edge technology in care management. As a major teaching affiliate of Harvard Medical School, Harvard Vanguard has a long-standing mission in clinical education and scholarship focused on improving clinical practice and outcomes.

The Department of Population Medicine (DPM), formerly the Department of Ambulatory Care and Prevention - a department of Harvard Medical School.  DPM faculty conduct teaching and research in ambulatory care, preventive medicine and population health, and is the nation's only department affiliated with a medical school that is jointly sponsored by a health plan (Harvard Pilgrim Health Care) through the Harvard Pilgrim Health Care Institute. DPM's mission is to improve the health of individuals through teaching and research focusing on populations and systems affecting their care.  DPM faculty collaborate with investigators and organizations domestically and globally on the evaluation of health care policy, improvement in health care delivery, and prevention.  DPM faculty teach students, residents, and fellows the skills that bring together individual patient care, public health, and health of populations.

Harvard Pilgrim Health Care (HPHC) is a not-for-profit health plan nationally recognized as a leader in health care quality and noted for innovation in chronic disease management and its diverse delivery models. The Harvard Pilgrim Health Care Institute (HPHCI) is committed to research in quality improvement, patient outcomes, and clinical practices, and has active collaborations with investigators at Harvard's Medical School and School of Public Health, as well as HMS-affiliated hospitals.

Each of our partnering organizations brings its expertise in clinical care, academic medicine, population health, and health systems and policy to our program, providing residents boundless opportunities for clinical education in general medicine and primary care, and for broader training in all the elements of population health.

Program Structure and Curriculum

The BWH Residency Program in Primary Care and Population Medicine has several features in its structure and curricula that make it distinctive:

  • Size: We are a small program within the larger Brigham Internal Medicine Residency family. There are 12 residents in our program, 4 residents in each year. Our small size affords opportunities for intensive small-group learning and great flexibility and responsiveness to resident initiatives in our program-specific curriculum.
  • Cohort Structure: Residents in PGY-1, PGY-2, and PGY-3 are scheduled to participate in outpatient-based blocks simultaneously to allow for intensive, interactive small-group learning. This structure is explicitly used to foster professional growth and the development of leadership skills.
  • Our Preceptor Model: Each of our residents is paired with a preceptor with whom he or she works throughout the three years of residency. This is a defining (and popular!) feature of our program.
  • Broad Educational Mission: Our program provides both outstanding clinical training in the care of individual patients and the skills and knowledge to contribute to improving the health of populations.
  • Leadership Development: As residents progress through the program they take on greater responsibility for program leadership, working with the Program Director and faculty in developing and implementing curriculum, electives, and project opportunities. Residents in PGY-3 take on many of the responsibilities traditionally assumed by chief residents.
  • Collaboration: In addition to their access to faculty and the education activities of the Department of Population Medicine and Harvard Vanguard, our residents work and learn with their peers and faculty in the DGM and categorical programs at Brigham and Women's Hospital and throughout the Harvard medical community.  Schedules are designed to allow participation in the broad array of educational activities offered by the Department of Medicine at the Brigham and beyond.
Clinical Training

Inpatient rotations occur at Brigham and Women’s Hospital (BWH), Faulkner Hospital (FH), and West Roxbury/Veterans Affairs Medical Center (WRVAMC); during inpatient rotations no distinctions exist between residents in our program and other residents in internal medicine at the Brigham. Ambulatory training in primary care is based at Harvard Vanguard Medical Associates (HVMA). Subspecialty training occurs primarily at HVMA and BWH, with electives at other institutions devised to meet residents’ individualized learning agenda.

Each resident manages his or her own primary care practice, partnered with a superb clinician-educator at one of HVMA’s health centers in the metropolitan Boston area. This one-on-one relationship between each resident and his or her clinical preceptor is a unique feature of this residency. Each resident practices side-by-side with his or her preceptor during the entire three years of residency, gaining valuable insight into longitudinal care and practice management. Sessions with BWH and HVMA subspecialists are integrated into the outpatient rotations so that all graduates are exposed to the full spectrum of outpatient management and learn advanced techniques in the care of complex patients. Throughout residency, the diverse patient population within HVMA provides residents with a full range of clinical training opportunities in a highly developed practice setting.

Ambulatory Blocks

During ambulatory blocks, residents practice at their clinics 3-4 times per week and attend longitudinal seminars and faculty-led didactic sessions three mornings per week. The remaining time is spent at subspecialty clinics, electives, or in independent project work.

Typical outpatient schedules for each year are:

PGY-1: 10 weeks outpatient; includes primary care practice, subspecialty care, and longitudinal seminars in areas such as clinical epidemiology, the patient-doctor relationship, health policy and systems, social justice and determinants of health, communication skills, geriatrics and palliative care. PGY-1 SCHEDULE TEMPLATE (pdf)

PGY-2: 6 months outpatient; includes primary care practice, subspecialty care, and seminars in areas such as clinical epidemiology, the patient-doctor relationship, health policy and systems, social justice and determinants of health, communication skills, leadership and management, geriatrics and palliative care.  Each resident acquires knowledge and skills in seminars and in independent sessions with mentorship to develop an individual project that will culminate in a presentation at the end of PGY-3. PGY-2 SCHEDULE TEMPLATE (pdf)

PGY-3: 6 months outpatient; includes primary care practice, subspecialty care, seminars in clinical epidemiology, the patient-doctor relationship, health policy and systems, social justice and determinants of health, communication skills, leadership and management, geriatrics and palliative care.  Each resident has significant flexibility in scheduling to pursue individual goals.  These include the development of particular areas of clinical expertise based on choice of subspecialty and other electives, and mentored research or a management project with a health plan or organizational leader, and/or international work.  Mentorship and dedicated time for each resident’s project increase as each resident brings his or her project to fruition at the conclusion of the program. PGY-3 SCHEDULE TEMPLATE (pdf)

Longitudinal Seminar Curriculum

A core element of this training program is a series of small-group seminars during outpatient blocks that develop the residents’ competencies in primary care internal medicine, while augmenting their academic and leadership abilities to make improvements in population health. The curriculum is continually reviewed, renewed, and updated, with residents playing a central role in curriculum development and delivery. The recent core seminars have included:

  • Clinical Epidemiology and Preventive Medicine: Led by William Taylor, MD. (weekly; 6 months/year, all years)
    A longitudinal seminar in which residents become highly skilled in interpreting the medical literature and applying evidence to clinical practice. With faculty guidance, residents choose topics, develop relevant teaching approaches, and lead each session.
  • Psychosocial Medicine and Communication Skills (aka “Patient/Doctor”): Led by Kathy Rexrode, MD and Jim Sabin, MD. (weekly; 6 months/year, all years) A longitudinal discussion about residents’ experiences as physicians taking care of patients. Content arises from patients and situations that the residents encounter in their clinical practices.
  • Clinical Case Discussion: Led by Howard Lewine, MD. (weekly; 6 months/year, all years) and other invited faculty from BWH, DPM, HVMA and other institutions 
    A weekly review of residents’ clinical cases. Designed to be a forum for exploring patient management issues that are not addressed elsewhere in the formal curriculum.
  • Faculty Didactics on Topics in Ambulatory MedicineGiven by invited faculty from BWH, DPM, HVMA and other institutions (1-2 weekly: 6 months/year, all years).
  • Resident Didactics on Topics in Ambulatory Medicine:  Given by residents (1 weekly: 6 months/year, all years).
  • Care of the Elderly Patient: Led by Eliza Shulman, DO, and others
    This series provides an introduction to primary care for older adults, incorporating didactic sessions, experience at an extended care facility, and precepted home visits with the residents’ patients.
  • Care at the End of Life: Led by Muriel Gillick, MD, and others
    This series provides an introduction to the unique aspects of care at the end of life, with didactics and experiences at a hospice.
The Resident as Teacher

Much of the content in the curriculum is developed with active involvement of the residents. Residents are mentored in their teaching skills, and progressively take on responsibility for the teaching of individual components of the curriculum under the supervision of the faculty. Peer education across all three years greatly enriches the curriculum by focusing on residents’ learning needs, and by developing residents’ abilities as educators and as leaders. The residents’ schedules are designed to allow participation with fellow residents and faculty in the broad array of educational activities offered by the Department of Medicine at Brigham and Women’s Hospital, and in seminars and other educational activities of Harvard Medical School’s Department of Population Medicine. Interested residents can serve as seminar leaders and take other educational roles in teaching courses at Harvard Medical School, with full participation in the faculty development programs offered at HMS.

Mentorship

Beginning in the first year of the program, each resident has a BWH mentor and two faculty mentors at DPM to help the resident with career planning, project selection, and the development of skills in research and population health. The program director matches each incoming resident with faculty preceptors in DPM based on the resident’s professional interests. In addition, mentorship occurs through the clinical relationships that develop with preceptors and others at HVMA.

The program director and other faculty throughout BWH, DPM and HVMA are actively involved in mentoring each resident. The program director meets with each resident often and faculty mentors are available throughout the year. In addition, our unique one-on-one precepting model provides residents consistent feedback, mentoring, and role modeling in the clinical setting throughout their entire residency. Residents are also encouraged to seek out mentoring relationships with faculty members throughout DPM, BWH, HVMA and HMS.

Research and Elective Opportunities

All residents have dedicated time for a longitudinal project chosen by the resident with faculty input and guidance. Residents often chose topics that focus on the care of defined populations. Residents take primary responsibility for choosing their topic, and are closely mentored by faculty drawn from the Department of Population Medicine, Harvard Vanguard Medical Associates/Atrius Health, Harvard Pilgrim Health Care, and Brigham and Women’s Hospital. These activities can help define career interests, and can facilitate entry into positions of academic, organizational and clinical leadership.

During either their junior or senior years, residents may spend up to one month away on an elective, either in the U.S. or abroad. These electives are scheduled during selected times in ambulatory blocks, with approval by the program director. All residents may also pursue other elective opportunities during ambulatory block time allocated to subspecialty or individual project work.

Summary

The BWH Program in Primary Care and Population Medicine is designed to be comprehensive and flexible to offer distinctive training for future leaders in general internal medicine. Through its innovative design, educational curriculum and unique organizational affiliations, the program provides opportunities for residents to explore interests and develop competencies in the multiple domains of primary care and population health, including clinical practice, teaching, research, and organizational leadership. Graduates of this program are prepared to make contributions as superb clinicians, as academic physicians and researchers, and as leaders able to improve systems of care for populations.

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